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Stage 4 shows abnormal, big, red blood cells on lab testing

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According to StatPearls , patients with pernicious anemia require lifelong vitamin B12 injections and may want to consider dietary changes for B12 deficiency

Br Med J 1:342 Barbero U, Fornari F, Guarguagli S, Gaglioti CM, Longo F, Doronzo B, Anselmino M, Piga A (2018) Atrial fibrillation in beta-thalassemia major patients: diagnosis, management and therapeutic options